When a patient enters a hospital or other medical facility for treatment, the patient is typically asked about health insurance that can be used to pay for the patient's treatment. If the patient is not covered by insurance or covered by a healthcare assistance program, then the patient is deemed to be a self-pay patient. Some self-pay patients are indigent or disabled and may qualify for benefits under a healthcare assistance program, such as Medicaid.
Even though the patient may be eligible for benefits under an assistance program, the patient may not be receiving benefits because the patient has not applied for assistance or has not completed the application process. Typically, the application process requires that one or more forms be completed and submitted. In addition, there may be a requirement for verification of certain information provided on the application.
Typically, medical facilities are focused on treating patients. The facilities have few, if any, resources that can be used to assist patients in obtaining benefits under a medical assistance program. However, if benefits can be obtained for the patient, then the medical facility can be paid for the treatment services that it rendered to the patient. Thus, there is a need for determining whether a patient qualifies for benefits under an assistance program, and if so, for applying for such benefits.
Each assistance program typically requires a specific application form. A single application form cannot be submitted for all possible assistance programs. Therefore, it is impractical to complete the application process for every possible assistance program for every patient. Thus, there is a need to make an initial determination as to whether a patient is likely to qualify for an assistance program and to identify a particular assistance program prior to starting the application process.
Once an assistance program is identified, the application for that assistance program must be completed. If the application form is incomplete or if the application form includes inconsistent answers, then there may be a delay in obtaining coverage or coverage may be denied. Some application forms include questions that are designed to verify the patient's answers and to combat fraud. A patient may, without fraudulent intent, answer these questions differently. If so, then the patient's application may be rejected or returned to the patient for an explanation. Thus, there is a need for guiding an applicant through the application process, so that the application form is completed consistently.